Vascular dementia: symptoms, causes, diagnosis and outlook in the UK

Dementia is the name for problems with mental abilities caused by gradual changes and damage in the brain. In vascular dementia the damage comes from the blood supply. When blood flow to parts of the brain is reduced, brain cells are harmed and eventually die, and the thinking skills those areas supported become harder to use.

The Alzheimer's Society describes several types of vascular dementia, including multi-infarct dementia, subcortical vascular dementia and stroke-related dementia. They all result from problems with the blood supply to parts of the brain, which then become damaged. The labels reflect which blood vessels are involved and how the damage built up, rather than separate diseases with different treatment.

The NHS notes that it is rare in people under 65, and that many people with vascular dementia also have Alzheimer's disease. Doctors sometimes call this a mixed picture. It matters because the symptoms then overlap, and because looking after blood vessel health remains worthwhile even when Alzheimer's changes are also present.

The NHS says symptoms can start suddenly or begin slowly over time, and that they tend to get worse. The pattern depends on which part of the brain has been affected, so two people with the same diagnosis can look quite different.

• Early signs listed by the NHS include slowness of thought, difficulty with planning, trouble with understanding, problems with concentration and changes to mood or behaviour.

• The Alzheimer's Society adds problems with organising, making decisions or solving problems, difficulty following a series of steps such as cooking a meal, and short periods of sudden confusion.

• Later symptoms named by the NHS include significant slowness of thought, disorientation, memory loss, difficulty finding the right words, severe personality changes, depression and mood swings, difficulty walking with frequent falls, loss of bladder control and increasing difficulty with daily activities.

According to the NHS, vascular dementia can follow narrowing and blockage of the small blood vessels inside the brain, a single stroke where the blood supply to part of the brain is suddenly cut off, or many "mini strokes" (transient ischaemic attacks) that cause tiny but widespread damage.

In many cases these problems are linked to underlying conditions such as high blood pressure and diabetes, and to lifestyle factors such as smoking and being overweight. The Alzheimer's Society says the biggest risk factor is age, with the risk increasing once a person reaches 65, and that some risk factors can be avoided.

Because the cause is vascular, the same measures used to protect against stroke and heart disease are relevant. The NHS says tackling these factors might reduce the risk of vascular dementia in later life, although it is not yet clear exactly how much the risk can be reduced.

The NHS advises seeing a GP if you think you have early symptoms of dementia, especially if you are over 65. It explains that if the condition is found at an early stage, treatment may be able to stop vascular dementia getting worse, or at least slow it down.

If you are worried about someone else, the NHS suggests encouraging them to make an appointment and perhaps going along with them. The Alzheimer's Society offers a symptoms checklist that can be printed and taken to the appointment, which can help when memory for events is unreliable.

Sudden changes need a different response. A new weakness on one side, drooping of the face, slurred speech or sudden confusion can be signs of a stroke, which is an emergency. Call 999 rather than waiting for a routine appointment.

A GP can do some simple checks to look for the cause of symptoms and can refer you to a memory clinic or another specialist if further tests are needed. The NHS lists the elements used to make a diagnosis.

The NHS is clear that there is currently no cure and no way to reverse brain cell loss that has already happened. Treatment aims to tackle the underlying cause, which may reduce the speed at which brain cells are lost. This often involves a healthy, balanced diet, losing weight if overweight, stopping smoking, getting fit, cutting down on alcohol and taking medicines to treat high blood pressure, lower cholesterol or prevent blood clots.

Other help reduces the impact of existing problems. The NHS names physiotherapy, occupational therapy, dementia activities such as memory cafes and psychological therapies. The Alzheimer's Society describes advice and support on its own pages and through a Dementia Support Line.

People often also need practical support with day-to-day living. The NHS points to social services and voluntary organisations, and notes that if you need help with daily living, or care for someone regularly, a care and support needs assessment can explain the options.

The NHS says vascular dementia will usually get worse over time, in sudden steps with quieter periods between, and that it is difficult to predict when a step will happen. Home-based help will usually be needed and some people eventually need care in a nursing home.

It also says treatment can help but vascular dementia can significantly shorten life expectancy, although this is highly variable and many people live for several years with the condition or die from some other cause. A realistic conversation with the memory clinic or GP is the best way to understand what this means for one person.

Planning ahead can make later stages easier. The NHS lists information on managing money, legal affairs and end of life planning. Doing this while the person can still take part in decisions is usually easier for everyone.

On the NHS the route normally starts with the GP, then a memory clinic or older adult mental health service, with scans arranged through the hospital. Treatment of the underlying vascular risk factors is often shared with the GP and, after a stroke, a stroke service.

Some people choose a private consultation with a neurologist, geriatrician or old age psychiatrist, mainly for quicker access to appointments and scans or a second opinion. The tests themselves are broadly the same. It helps to ask that any private findings are shared with the GP so that care stays joined up.